Metabolic acidosis: pathophysiology, diagnosis and management

@article{Kraut2010MetabolicAP,
  title={Metabolic acidosis: pathophysiology, diagnosis and management},
  author={Jeffrey A Kraut and Nicolaos E Madias},
  journal={Nature Reviews Nephrology},
  year={2010},
  volume={6},
  pages={274-285}
}
Metabolic acidosis is characterized by a primary reduction in serum bicarbonate (HCO3−) concentration, a secondary decrease in the arterial partial pressure of carbon dioxide (PaCO2) of ∼1 mmHg for every 1 mmol/l fall in serum HCO3− concentration, and a reduction in blood pH. Acute forms (lasting minutes to several days) and chronic forms (lasting weeks to years) of the disorder can occur, for which the underlying cause/s and resulting adverse effects may differ. Acute forms of metabolic… 
Metabolic Acidosis and Chronic Kidney Disease
TLDR
Treatment with base in the form of Shohl’s solution, sodium bicarbonate, or increased amounts of fruits and vegetables can all be successful in raising serum biccarbonate concentration, but it is recommended it be raised close to or at the normal level of 24 mmol/L.
Treatment of acute metabolic acidosis: a pathophysiologic approach
TLDR
Given the important effects of acute metabolic acidosis on clinical outcomes, more intensive study of the pathogenesis of the associated cellular dysfunction and novel methods of treatment is indicated.
Metabolic Acidosis and Cardiovascular Disease
TLDR
The chapter reviews available information on the impact of acute and chronic metabolic acidosis on cardiovascular function, the possible underlying mechanisms, and theimpact of base therapy.
Pharmacologically-Induced Metabolic Acidosis
TLDR
Determinations of arterial blood gases, the serum anion gap and the serum osmolar gap are helpful in delineating the pathogenesis of the acid-base disorder, and in all cases of drug-related metabolic acidosis, discontinuation of the culprit medications and avoidance of readministration is advised.
Pathophysiologic Approach to Metabolic Acidosis
TLDR
Deviations from the presumed 1:1 ratio in this relationship that is present in a high AG metabolic acidosis can be used to diagnose complex mixed acid–base disorders.
The Use and Interpretation of Serum Bicarbonate Concentration in Dialysis Patients
TLDR
The genesis of the metabolic acidosis of CKD, the value and limitations of the parameters used to assess its course, the factors affecting its onset and severity, its impact on cellular function and clinical outcome, and the level of acid–base parameters that should be achieved to ensure the best clinical outcomes are summarized.
Acid-Base Disorders
TLDR
Treatment of acid-base disturbances focuses on correcting the underlying pathophysiology and may include vasopressor support, blood transfusion, renal replacement therapy, ventilator adjustment, and antibiotics when necessary.
The Janus faces of bicarbonate therapy in the ICU
TLDR
Facing metabolic acidemia, a short list of strong indications (gastrointestinal or urinary loss of bases, ethylene glycol, methanol and salicylate poisoning) and non-indications (diabetic ketoacidosis, tumor lysis syndrome) have been recommended.
Buffer Therapy in Acute Metabolic Acidosis: Effects on Acid-Base Status and Glomerular Permeability
TLDR
These data demonstrate a remarkable tolerance of the glomerular filter to severe acute acidosis and bicarbonate therapy, and cast light on the buffer mechanism in erythrocytes and the ability of different acid-base parameters to evaluate the extent of an acid- base disorder.
Non-Anion Gap Metabolic Acidosis: A Clinical Approach to Evaluation.
  • Mandana Rastegar, G. Nagami
  • Medicine
    American journal of kidney diseases : the official journal of the National Kidney Foundation
  • 2017
TLDR
The present case was selected to highlight the differential diagnosis of a non-anion gap metabolic acidosis and illustrate a systematic approach to this problem.
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